Chapter 283 Acidosis
The Huang Jiacai brothers and sisters never lose their grip at critical moments. This set of equipment is really unique in the city because it was customized by Huang Jiacai. The connecting rod between the guide and the steel plate has been lengthened, making it suitable for particularly obese patients. He also customized some other weird instruments, such as extended plate screws, just in case of emergencies.
After the fracture was reduced, the steel plate was successfully placed, and the locking screws were placed under the guidance of the guide. With long steel plates and high spans, stress is dispersed and fractures are bridged.
"How come other people have equipment but yours doesn't? Are you trying to cause trouble?"
Director Ouyang was so embarrassed and disgraced on the stage that he lost his temper with the equipment dealer and those on stage.
He had just been asked to dig three feet into the ground to get the equipment, but he still couldn't get it. Several larger companies have asked if anyone can make a set of equipment for a patient weighing 400 pounds. It's useless to scold people to death. . But the equipment dealer in Yangping had it and delivered it. Director Ouyang had reason to suspect that the equipment dealer was not interested.
If it weren't for Yang Ping's rescue, and if it weren't for the help of Yang Ping's equipment dealer, this operation would really not have been possible.
"I'm sorry, I'm sorry, I'm sorry. We didn't do our job well. Our manager will be here soon and come to apologize in person." The equipment dealer who followed the stage did not dare to refute even a word.
Director Ouyang is pretty good. If you meet Director Bai and something hits you in front of you, you can only nod and bow and smile.
At this time, no matter whether there is any mistake or not, this can only be done until Director Ouyang is relieved. Now the equipment dealer is a punching bag and a sandbag to be beaten. In this industry, if you don’t have the ability to pretend to be a grandson, you can’t make money, especially when you are in charge of surgery. Difficulties, not being able to use any equipment smoothly, and scolding is inevitable.
After the screws were drilled, the C-arm X-ray machine showed no problem. Dr. Jin used the electrosurgical wire to measure the force lines of the lower limbs, the anterior superior iliac spine, the center of the patella, and the middle of the first and second toes. It was just like aiming with a gun, three points and one line. ,normal.
This surgery is an innovation in fracture treatment technology. It is called biological fixation and is suitable for long bone fractures in the limbs. Of course, this cannot be done for fractures of the radius and ulna. Due to the precise rotation function of the radius and ulna, it is treated as an intra-articular fracture and requires anatomical reduction and strengthening. fixed.
This type of femoral shaft fracture does not require anatomical reduction or restoration. As long as the length and line of force are restored to normal, even if the purpose is achieved, the messy bone fragments in the middle can be ignored. These bone fragments look messy and have not been repaired. Treatment, in fact, the blood supply is protected, and they will eventually grow into one piece, and the human body will reshape it. In the future, the femur will not be different from its normal shape and will not have any impact on its function.
This is the progress of medicine, the innovation of concepts, bringing about the innovation of surgical techniques and equipment, and finally improving the treatment effect.
"What a crappy thing, don't bring this thing again." Director Ouyang fiddled with the original guide a few times and threw it directly into the trash can, so that his anger could be relieved a little.
The manager of the equipment manufacturer, who was really coming, hurried to the operating room and kept hunching over: "Director Ouyang, our service has not kept up and we have caused trouble for you. Look, give us a chance and come together after get off work." Juju, let me make a proper apology to my brothers?”
Being scolded like a grandson, let the director calm down his anger, and then invite him to eat and drink. This is indispensable. The quality of this meal cannot be low.
I feel comfortable in all aspects, and I still have to do business. After all, this is not a subjective mistake, but that I really don’t have the equipment. I also transferred the goods to the brother company, but they still don’t have it.
The manager asked the attendant in a low voice to learn about the situation, and then he learned that a small company had sent equipment. In response to Director Ouyang's urgency, the manager glanced at Huang Jiahui, a girl who was inexperienced in the world.
I took another look at the special guide placed on the instrument table, and wondered how there could be such a weird guide. I have been immersed in the industry for so many years, and I can be considered an expert in equipment.
Director Ouyang took off his surgical gown. The manager quickly went up to apologize and help untie the laces. The attendant moved the stool and adjusted the height. Director Ouyang did not sit down, but walked to the reading light to watch the movie. Yang Ping stood there.
"Lao Jin, explain clearly to the family members that these bone fragments do not need to be reset and will not affect their functions." Director Ouyang told Dr. Jin.
The most difficult part of this kind of surgery is the family members. They don't understand. When they saw the X-rays after the surgery, they thought the doctor was too poor, the surgery was not done well, and the bones were in a mess.
The doctor explained a lot of medical principles, but the family members didn't understand anything. The last sentence was: The bones seen on the X-ray are almost the same as before the operation.
In fact, doing this will heal the fracture faster and better than cutting it open and putting the bone pieces back together.
This kind of surgery cannot be done for joint fractures. Joint fractures must be pieced together piece by piece, so that the broken mirror can be reunited.
Director Ouyang came over and planned to ask Yang Ping how to achieve a successful pry reset in one go, but the equipment manager was nearby and could not speak out because of his face.
Yang Ping does not have a lecture impulsive disorder, so naturally he will not take the initiative to explain. Some people like to learn, and some people do not like to learn. Everyone is free to do so. If you want to know more, just ask him directly and he will explain. If you don’t ask, he will not take the initiative to explain. You tell me, except for Song Zimo.
After the operation is over, it is also challenging for the patient to move to bed.
When entering the operating room, the flat car was not wide enough and the patient was pushed directly in with a bed. Nowadays, the width of the bed sheet is not enough, so the nurse thought of a way to use a few sheets to spread it across the bed, so that it can work. Six people, three on each side, pulled hard on one side and pushed on the other side. The patient only moved a little bit until the lumbar disc was almost herniated.
I had to add two more young men, and five people pulled together to pull the patient to the bed.
The manager of the equipment dealer and the attendants also participated and worked very hard. At this time, they wanted to prove their efforts to Director Ouyang.
The patient was under general anesthesia with tracheal intubation. The commonly used anesthesia for this kind of surgery is sciatic nerve and femoral nerve block, or combined spinal and epidural anesthesia. However, no matter which one, because the fat is too thick, positioning is extremely difficult.
Combined spinal-epidural anesthesia requires injecting anesthetic into the spinal canal. The anesthesiologist's conventional lumbar puncture needle may not reach the spinal canal at all. The puncture path is too thick, and the conventional puncture needle is relatively too short.
"Wei Danian, wake up!" The anesthesiologist slapped the patient's face, hoping to wake him up through stimulation and prepare for extubation.
Dr. Jin reminded the anesthetist: "To put it another way, not long ago, in the emergency department of a hospital, an old lady suffered cardiac and respiratory arrest. The doctor used a fist hammer method to induce cardioversion. With one punch, the old lady and her son were killed. Slap, you bastard, people are like this, and you still hit people, and you hit them in front of me, you are so bully, you are bullying me, a fool."
The anesthetist was so frightened that he stopped. This was a bad habit, so he still moved his mouth but not his hands. He shouted at the patient at the top of his voice: "Wei Danian, wake up, the operation is done."
The patient was dazed. He opened his eyes to respond, then closed his eyes again. He opened his eyes and was breathing spontaneously. He could be extubated. The anesthetist used a suction device to clear the secretions from the respiratory tract again and successfully pulled out the tracheal tube.
"The blood pressure is down!"
Dr. Jin kept staring at the monitor. His blood pressure actually dropped to 76/35mmHg, his breathing became deeper, and the patient inhaled and exhaled fiercely.
"Ketoacidosis?"
The patient had diabetes, took deep breaths, and his blood pressure dropped. The anesthesiologist immediately thought of ketoacidosis.
"Re-intubate!" The anesthesiologist quickly re-inserted the tracheal tube.
"Check fingertip blood sugar with a blood glucose meter, draw blood to check blood routine, biochemistry, liver and kidney function, blood gas analysis -" the anesthesiologist reported a series of oral medical instructions.
He was experienced and took deep breaths. This was acidosis. The patient had diabetes and his blood sugar was 38mmol/l when he was admitted. He did not dare to operate until the insulin was adjusted to satisfaction. Could it be that the surgery stimulated the blood sugar to spike up?
In the operating room, the patient's life safety is the responsibility of the anesthesiologist, so the anesthesiologist is naturally nervous.
"Blood sugar 6.2mmol/l" the nurse looked at the data on the blood glucose meter.
"It's not high? What's going on?" the anesthesiologist was confused.
Director Ouyang and Dr. Jin also became nervous. They suspected that fat embolism caused pulmonary embolism, but the blood oxygen was not low.
"Check the blood lactate!" Yang Ping suggested.
"Well, check the blood lactate." The anesthesiologist told the nurse.
Emergency specimen transportation does not require manual transportation. The hospital has a dedicated automated logistics system. The nurse only needs to label the specimen, scan it into the computer, and then put it into the logistics tube. It will automatically be sent to the laboratory department through the transportation pipeline.
The results came out quickly: bicarbonate ions were 8mmol/l, pH was 7.14, and blood lactate concentration was 2.8mmol/l.
"Acidosis is correct, it's lactic acidosis, not ketoacidosis!"
The prognosis of lactic acidosis is critical and the mortality rate is high.
(End of chapter)